Tailoring immunization programmes to reach underserved groups – the TIP approach

The success of TIP underlines how application of research evidence from behavioural economoics, the medical humanities, psychology and neuroscience can help decision-makers understand vaccine acceptance decisions.

SAGE Working Group on Vaccine Hesitancy, November 2014

Suboptimal vaccination coverage threatens to jeopardize progress towards disease elimination and allow vaccine-preventable diseases to re-emerge in the European Region. The ability and commitment of Member States to close immunity gaps and equitably extend the benefits of vaccination are crucial if the Region is to remain vigilant and meet the goals of eliminating measles and rubella and maintaining the polio-free status it has enjoyed since 2002.

To equip Member States to better diagnose the factors influencing vaccination intentions, decisions and behaviours, WHO/Europe developed the Guide to tailoring immunization programmes (TIP).

The TIP approach

TIP was developed by WHO/Europe to assist health care professionals, public health authorities and decision-makers in tailoring services to close immunity gaps. 

It comprises proven methodologies and tools:

  • to identify populations susceptible to vaccine-preventable diseases (VPD);
  • to diagnose supply- and demand-side barriers and motivators to vaccination; and
  • to recommend evidence-informed responses to sustain vaccination. 

Pilot testing and further roll-out

During 2013–2016, national TIP projects in Bulgaria, Germany, Sweden and the United Kingdom have used the Guide to target sub-populations vulnerable to disease outbreak due to lower vaccination coverage, such as the Roma, undocumented migrants, Somalis, orthodox Jewish and anthroposophic communities, as well as health care workers and communities and families with a preference for herbal dietary supplements and alternative vaccination schedules.

The TIP approach has also been adapted for influenza (TIP FLU) and for antimicrobial resistance (TAP). The TAP Guide and a newly developed TIP FLU Pregnant Women Guide are expected to be launched in 2016.

In 2015, prompted by the Scientific Advisory Group of Experts on Immunization (SAGE) and the SAGE Vaccine Hesitancy Working Group, WHO/Europe took the initiative to develop a global TIP Field Guide for use at field, district and community health levels in lower-income settings. While TIP implementation in European countries has relied heavily on external technical assistance, the new Field Guide is intended for use by district level health authority staff – hence meeting the Guide's full potential in countries and regions where the need is greatest to drive demand and reduce barriers to vaccination. This Field Guide will be launched in late 2016 and piloted shortly thereafter.